Claims Adjudication

Pursuing a Proactive Denials Strategy Helps Resolve Denials and Prevent Recurrence

A look at how one company is partnering with healthcare organizations to use data and technology to address the root causes of long-standing problems, including denials.

HFMA July 1, 2019

Providers push arbitration approaches used in some state surprise-bill laws

What should Congress learn from states’ experiences with laws attempting to curtail surprise healthcare bills?

Rich Daly June 13, 2019

Inconsistent address data could delay Medicare payments

One health system found in its Medicare enrollment system that addresses were missing for new facilities. Another found addresses still listed for a demolished facility.

Rich Daly June 7, 2019

Success Factors for Getting High-Cost Drugs Approved

The University of Rochester Medical Center’s high-cost drug manager works to help patients get access to appropriate drugs and mitigates the financial risk associated with buying and administering them.

Lola Butcher October 9, 2018

Avoid ED Claim Challenges by Developing CDI Teams

UnitedHealthcare’s new policy of auditing certain emergency department claims should prompt hospitals to seek the expertise of clinical documentation improvement teams in outpatient claim processing. 

Lola Butcher May 9, 2018

Strategies for Managing Third-Party Liability Claims

Boston Medical Center has achieved average cycle times of 90 and 120 days respectively for workers’ compensation and motor vehicle accident claims.

CLAIMS MANAGEMENT February 27, 2018

Payment on Motor-Vehicle Claims: An Untapped Source of Revenue in Uncertain Times

George Abatjoglou explains the importance of knowing how to process a common, but often mishandled, type of claim. 

George Abatjoglou February 21, 2018

Revenue Cycle Strategist: November 2017 Issue

Subscribers can view the December 2017/January 2018 issue of Revenue Cycle Strategist.

HFMA February 1, 2018

Video: Tips for Secure Medical Record Transmission to Payers

Common mistakes are not using security options to send records and not tracking what data or claims are sent. 

HFMA January 17, 2018

Electronic Claim Processing Can Save Millions of Work Hours

If providers fully adopt automated processes for claim transactions, a minimum of 1.1 million hours of administrative work could be saved per business week each year, according to a 2016 CAQH study. 

HFMA April 10, 2017
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